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HomeMy WebLinkAboutCLE200600235 Legacy Document 2014-12-02Application for Zoning Clearance § ❑ Zoning Clearance = $35 n PLEASE REVIEW ALL 3 SHEETS Tax map and parcel: C M 00_ G0 _W ~ V 6 ✓A 5 Existing Zoning: mc Parcel Owner:4%LYIMiZ24160 Parcel Address: ay .Z City J/P State y Zip (include suite or floor Contact Person (Who should we call /write - concerning this project ?): s4 / ✓1i07 �f C� /� /G ! •� �� Address / i % `��`� N >&—/ 'c, City LA /azk5 L State t1gy Zip, Daytime Phone 97V —, /ESL Fax # L_ E -mail Business Name /Type: Previous Business on I Proposed use: yefeD /SfJY /6 .77 rJ, SEE CONDITIONS OF APPROVAL IF THE CLEARANCE IS FOR FIREWORK OR CHRISTMAS TREE SALES (Sheet 1) Circle (if applicable): Fireworks / Christmas Tree *This Clearance will only be valid on the parcel for which it is approved. If you change, intensify or move the use to a new location, a new Zoning Clearance will be required. certify that I own or have the owner's permission to use the space indicated on this application. I also certify that the information is true and accur e o the b st of my knowledge. I have read the conditions of approval, and I understand them, and that I will them. e of Busine ner oi,Agent Date ame APPROVAL INFORMATION [ ] Approved as proposed [ ] Approved with conditions ] Backflow device and /or current test data needed for this site. Contact ACSA 977 -4511, x119. ] No physical site inspection has been done for this clearance. Therefore, it is not a determination of compliance with the existing site plan. ] This site complies with the site plan as of this date. Building Official Date Zoning Official Date Other Official Date FOR OFFICE„IJSF ONLY Y /,3 !J Jlk CLE # �C / ,1 ((��� ] Fee Amount $ � L ate Paid v who? L� R cei t # &,) Rz T TCk# I (A By: 6hM4 County of Albemarle Department of Community Development 401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126 5/1/06 Page 2 of4 Applicant to complete the following: Do you have one of the following? ❑ YES ❑ NO Tax Map and Parcel Number and or; Address o use (include unit or floor if appropriate) YES ❑ NO Do you have a Floor Plan (sketch or an architectural drawing) that includes the following, and if so please provide it with the application? The total square footage of the use and /or; The square footage of each room or area of use; Use of each room or area If using less than the entire structure, note the location within the structure. Zoning Tech to c Violations: ❑ YES ❑ NO If so, List: Variance: ❑ YES ❑ NO If so, List: the Intake to complete the following: ❑ YES © NO Is use in LI, ICI or PDIP zoning? If so, give applicant a Certified Engineer's Report (CER) packet. ❑ YES Q NO Will there be food preparation? If so, give applicant a Health Department form. Zoning review c ,h not begin until we receive approval from Health Dept. F DATE ❑ YES Z NO Is parcel on private well and septic? If so, give applicant a Health Department form. Zoning review can not begin until we receive approval from He lth Dept. FAX DATE 7 YES ❑ NO Won public water and sewer? F-1 YES E] NO Will you be putting up a new sign of any kind? If so, obtain proper Sign permit. Permit # ❑ YES ❑ NO Will there be any new construction or renovations? If so, obtai??��t a ro er Permit. Permit #Ot 1 "' 4 ",a lie, ❑ YES [] NO Is this for sale of Fireworks? If so, obtain a copy of F/R permit. Permit # Proffers: ❑ YES ❑ NO If so, List: SP's: ❑ YES ❑ NO If so, List: 5/1/06 Page 3 of